Ticket for Outdoor Patient
| Ward No. 27 | U-PHC No. | Registration No. 00625 | Date 30/12/2019 |
| Token No | SM/19-20/3854 18/04/2020 | Serial | 003 |
| Patient Name | Mr. AJOY RASUYA | Contact No | 7044017092 |
| Address | B B GHOSH ROAD HARIJAN BASTI SERAMPORE 712203 | Age | 16 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | 35 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||